It has been somewhat recently discovered that many supposed leg and foot deformities are really caused by hip joint problems. For example, in-toedness may well be caused by internal femoral torsion rather than tibial torsion. However, many corrective appliances are still designed to correct the problem by applying corrective torsional forces through the feet. This is often done via a transverse "Dennis Brown" bar with outwardly pivoted shoes mounted to the bar ends. The patient's feet are placed in the shoes which, are then turned to apply torsional forces to the lower legs. If the problem is actually in the hip, correctional forces at the feet are usually insufficient to place the hip under sufficient corrective strain. Further, the forces applied to the hip joint must be transferred through the knee. It is not uncommon for individuals having been exposed to such corrective procedures to later develop knee problems.
U.S. Pat. Nos. 4,336,795; 2,963,020; and 4,303,065 all deal with forms of the "Dennis Brown" bar, making use of shoes or other attachments mounted at the outward ends of elongated bars for selectively turning the wearer's feet in or outwardly. These apparatus function well for a correcting problems that may be alleviated by applying tibial torsion. However, they are not nearly so effective for correcting hip rotational problems. It has therefore becomes desirable to obtain some form of apparatus by which fibular rotation may be used to more directly correct hip rotational problems without interfering with or applying unnecessary forces to the knee or ankle joints.
U.S. Pat. No. 3,815,589 to Bosley discloses a brace assembly for controlling hip rotation in a child. This device represents a direct approach to the hip rotational problem by providing a brace mechanism that works both legs against one another and against "suspender" straps that extend from the brace upwardly around the wearer's shoulders. This device is intended primarily for correcting very early hip deformation in children. Adjustments are possible by use of cuff members that are slidably attached to leg frames. The cuff members will slide in an arch to facilitate adjustment of the amount of torsion desired to be applied to the child's legs. One cuff is intended to be mounted to the child's upper leg, while the remaining cuff fits the lower leg. Both pairs of cuffs are joined by a rigid center connector.
While the Bosley brace assembly represents a more direct approach to the hip rotation problem, it does not do so without certain difficulties. Firstly, the adjustments are preferably made by a doctor, therapist, or other knowledgeable person who properly understands the correct adjustments for applying correct amounts of torsional forces to the wearer's legs. Thus, the adjustments are made periodically and the positions are set and remain between adjustments. The child's legs must be fitted to the preset cuff members. This is a very frustrating procedure for the person who must force the child's legs into awkward positions. It is even more discomforting for the child who must be subjected to this discomfort whenever the brace mechanism is to be attached or dismounted. This procedure occurs frequently since such braces are often used only at night time.
U.S. Pat. No. 3,958,567 discloses a substantially improved apparatus for applying tibial torsion without substantially involving the knee joint. This device includes an angular cuff arrangement by which the upper leg of the patient is gripped as well as the lower leg with the knee in between. The knee is held at an angle by the cuff arrangement. A torsion applying cuff then fits over the wearer's shoe to apply rotational forces directly to the tibia. A somewhat similar appliance is shown in the 1963 patent (U.S. Pat. No. 3,086,522) to Frohmaderf and an earlier patent (U.S. Pat. No. 3,304,937) to Calender, Jr.
U.S. Pat. No. Re. 30,501 to Almeida discloses a universal knee orthosis that includes a pivoted pair of cuffs used to prevent hyper-extension of the wearer's leg and, generally to limit flexural motion of the knee joint. The device is not intended for use in applying torsional forces to the wearer's leg. Similar apparatus is disclosed in the 1962 Patent to Palmer (U.S. Pat. No. 3,055,359); a leg brace structure shown in the 1954 Patent to Nelson (U.S. Pat. No. 2,690,176); the hinged joint for leg braces shown in the 1951 patent to Cohan (U.S. Pat. No. No. 2,545,843); an orthopedic device disclosed by Bierig (U.S. Pat. No. 1,585,828); the hinge for knee brace disclosed by Applegate (U.S. Pat. No. 4,088,130); the brace structure shown by Sichau (U.S. Pat. No. 3,805,773); and U.S. Pat. No. 3,171,407 to R. D. Rogers which shows an orthopedic foot brace of a type used to simply brace the wearer's foot or set angulation of the foot relative to the tibia.
U.S. Pat. No. 4,243,027 to LaCourse discloses a hip stabilizer. This device makes use of a rigid metallic frame set about the wearer's lower torso to control movement of the individual's legs and to promote normal muscular development. The device includes adjustable features that adapt the apparatus to different leg lengths. The device can be applied to the hips and legs to control motions of the legs and in walking. It is not intended to place the legs under torsional forces or to correct deformities but merely to hold the legs in normal orientation to facilitate walking and "normal" muscular development.